English Second Language

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Back to Main Menu �鶹��Ƶ Adult High School Adult Basic Education Digital Literacy Classes English Second Language High School Equivalency (HSE)Integrated English Literacy and Civics Education Staff

Penny Wacaster

Director of College and Career Readiness & Human Resources Development
828-659-0417

English Second Language

Literacy Education Information System (LEIS) – Student Admissions Data Collection Form

Last Name

First Name

Middle Name(s)

Address

Address Line 2

City

State

ZIP Code

County

�鶹��Ƶ Phone

Cell Phone

Email Address

Date of Birth

Social Security Number

Gender

Ethnicity

Race

Last School Attended

Highest Grade Completed

Employment

License Information (only if under 18 and enrolled in community college)

License Number

Issue Date

State

Special Programs

None apply

Student with basic skills plus

Re-entry program (correctional)

Male or female on parole/probation

�鶹��Ƶ literacy program

English as a Second Language (ESL) student

English literacy and civic education

Student in workforce program

Student Details

None apply

Student is in the Foster Care program

Recently arrived immigrant (ESL) Cultural Barriers

�鶹��Ƶless student (THR) age 11 or under

Situations

�鶹��Ƶ disaster program

Temporary agricultural worker (more than 27 weeks)

Agricultural immigrant

Single parent

Disabilities

None apply

Physical disability

Emotional disability

Learning disability

By writing my signature here, I certify that the information provided is true and complete to the best of my knowledge.

Signature

Date

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Quick Links

College and Career Readiness

English Second Language

Literacy Education Information System (LEIS) – Student Admissions Data Collection Form

License Information (only if under 18 and enrolled in community college)

Special Programs

Student Details

Situations

Disabilities